A Needs Assessment of a A Needs Assessment of a Home Health Agency & Home Health Agency &

Education PlanEducation Plan

Madjil Clark, BSN, RN, Charity Ebert, BSN, Madjil Clark, BSN, RN, Charity Ebert, BSN, RN, RN,

Andrea Englund, BSN, RN & Rita Million, Andrea Englund, BSN, RN & Rita Million, BSN, RNBSN, RN

IntroductionIntroduction Home Health agencies are paid on a Home Health agencies are paid on a

prospective payment system (PPS)prospective payment system (PPS)

Payment is determined by Payment is determined by completion of a data set Outcome completion of a data set Outcome Assessment and Information Set Assessment and Information Set (OASIS) (OASIS)

CMS mandated changes to the CMS mandated changes to the payment structure of Home Health payment structure of Home Health Agencies effective January 1, 2008Agencies effective January 1, 2008

Introduction Introduction

Changes are based on a Changes are based on a retrospective review of Medicare retrospective review of Medicare claims that demonstrate a decrease claims that demonstrate a decrease in home health visits per episode in home health visits per episode while patient acuity (case mix) while patient acuity (case mix) increased increased

Translates into inaccurate Translates into inaccurate reimbursement system reimbursement system

PPS Regulatory Changes PPS Regulatory Changes

Two new OASIS questions Two new OASIS questions Expanded Home Health Resource Expanded Home Health Resource

Group (HHRG) similar to a DRG Group (HHRG) similar to a DRG Change to a 3 tier therapy threshold Change to a 3 tier therapy threshold Non-Routine Supply (NRS) add on Non-Routine Supply (NRS) add on Addition of 2 more outcomes that will Addition of 2 more outcomes that will

be publicly reported be publicly reported

Example of an OASIS Example of an OASIS question question

MO110MO110 Episode TimingEpisode Timing: : Is the Medicare home Is the Medicare home

health payment episode for which this health payment episode for which this assessment will define a case mix group an assessment will define a case mix group an “early” episode or a “later” episode in the “early” episode or a “later” episode in the patient’s current sequence of adjacent Medicare patient’s current sequence of adjacent Medicare home health payment episodes?home health payment episodes? Early Early LateLate UK- Unknown UK- Unknown NA- Not Applicable: No Medicare case mix group to be NA- Not Applicable: No Medicare case mix group to be

defined by this assessmentdefined by this assessment

Target Population of the Target Population of the Transformation Transformation

Home Health Agency of a non-profit Home Health Agency of a non-profit Medical CenterMedical Center

Primary patient population >65years old Primary patient population >65years old

Professional staff of RN, PT, OT, SLP who Professional staff of RN, PT, OT, SLP who complete the OASIS assessment complete the OASIS assessment

Entire agency impacted Entire agency impacted

Needs Assessment- Focus Needs Assessment- Focus

Focus on Staff needs Focus on Staff needs

Focus on Management needs Focus on Management needs

Focus on Patient needs ????Focus on Patient needs ????

Needs Assessment-Needs Assessment-Strategies Strategies

SWOT analysis of the agency SWOT analysis of the agency

Survey of the staff Survey of the staff

Focus Groups Focus Groups

Review of agency data Review of agency data

Threats

Opportunities

Weaknesses

Strengths

OrganizationalNeeds

Identified

SWOT Needs Assessment

SWOT Analysis SWOT Analysis

Average Case Mix Weight, by Month2006

1.377

1.58

1.396

1.517 1.538

1.465

1.607

1.511

1.352 1.375

1.574 1.56

1.2

1.3

1.4

1.5

1.6

1.7

Jan-06

Feb-06

Mar-06

Apr-06

May-06

Jun-06

Jul-06

Aug-06

Sep-06

Oct-06

Nov-06

Dec-06

Avg

of

Csx

MxW

gt

Case MixWgt

Average Case Mix Weight, by Month2007

1.523 1.52 1.5581.432 1.471 1.507

0

0.5

1

1.5

2

Jan-07

Feb-07

Mar-07

Apr-07

May-07

Jun-07

Jul-07

Aug-07

Sep-07

Oct-07

Nov-07

Dec-07

Avg

of

Csx

MxW

gt

Case MixWgt

Quality MeasureQuality Measure Percentage Percentage BryanLGHBryanLGH

State AverageState Average National Average National Average

Percentage of patients who get better at Percentage of patients who get better at walking or moving aroundwalking or moving around

33%33% 42%42% 42%42%

Percentage of patient who get better at getting Percentage of patient who get better at getting in and out of bed in and out of bed

54%54% 56%56% 53%53%

Percentage of patients who have less pain Percentage of patients who have less pain when moving around when moving around

58%58% 62%62% 63%63%

Percentage of patients whose bladder control Percentage of patients whose bladder control improves improves

57%57% 48%48% 50%50%

Percentage of patients who get better at Percentage of patients who get better at bathing bathing

61%61% 64%64% 64%64%

Percentage of patients who get better at taking Percentage of patients who get better at taking their medicines correctly (By mouth)their medicines correctly (By mouth)

30%30% 37%37% 42%42%

Percentage of patients who are short of breath Percentage of patients who are short of breath less often less often

68%68% 63%63% 61%61%

Percentage of patients who stay at home after Percentage of patients who stay at home after an episode of home health care ends an episode of home health care ends

73%73% 72%72% 68%68%

Percentage of patients who had to be admitted Percentage of patients who had to be admitted to the hospitalto the hospital

22%22% 24%24% 29%29%

Percentage of patients who need urgent, Percentage of patients who need urgent, unplanned medical care unplanned medical care

18%18% 18%18% 21%21%

Problem StatementProblem Statement

Staff needs to be educated and have a Staff needs to be educated and have a thorough understanding of the OASIS thorough understanding of the OASIS assessment, changes to the OASIS assessment, changes to the OASIS questions, and strategies to assist with questions, and strategies to assist with accurate documentation. An education accurate documentation. An education plan needs to be developed and plan needs to be developed and implemented to meet staff needs and implemented to meet staff needs and achieve the desired outcomes.achieve the desired outcomes.

Desired OutcomeDesired Outcome

Staff will document accurate OASIS Staff will document accurate OASIS assessmentsassessments

Staff will understand the importance of Staff will understand the importance of accurately documenting the OASIS as it relates accurately documenting the OASIS as it relates to agency reimbursement and benchmarking to agency reimbursement and benchmarking clinical outcomes clinical outcomes

Staff will utilize the OASIS assessment to drive Staff will utilize the OASIS assessment to drive the development and focus of the plan of care the development and focus of the plan of care

Transformation PlanTransformation Plan

Learning styles of cliniciansLearning styles of clinicians Content of the education plan Content of the education plan Learning strategies to support the Learning strategies to support the

transformation transformation Timelines and sequencing of Timelines and sequencing of

activities activities

Project TeamProject Team

Includes Management, IT staff, Includes Management, IT staff, nursing and therapy staff- (Primary nursing and therapy staff- (Primary Stakeholders)Stakeholders)

Primary Responsibility: Facilitate the Primary Responsibility: Facilitate the transformation of the agency through transformation of the agency through a needs assessment, develop and a needs assessment, develop and implement an education plan, and implement an education plan, and evaluate the project evaluate the project

Staff Education PlanStaff Education Plan

Learning Styles assessment for each Learning Styles assessment for each clinician clinician

Web based education of the OASIS Web based education of the OASIS Participation in formal education Participation in formal education

training training Lecture and video Lecture and video

Application of knowledge through Application of knowledge through case study review case study review

TimelineTimeline

Phase 1 Milestones (December 10, 2007) Phase 1 Milestones (December 10, 2007) Needs assessmentNeeds assessment All staff education activities All staff education activities Finalize testing of computer upgrade Finalize testing of computer upgrade

Phase 2 (December 26, 2007)Phase 2 (December 26, 2007) Mandatory Staff meeting Mandatory Staff meeting Finalize agency process changes and Finalize agency process changes and

communicate communicate

Timeline Timeline

Phase 3 (December 27, 2007)Phase 3 (December 27, 2007)

Gantt ChartGantt Chart

EvaluationEvaluation

Framework for Program EvaluationFramework for Program Evaluation Rationale for Selection of ModelRationale for Selection of Model

CDC Framework for Program CDC Framework for Program EvaluationEvaluation

Significance of the Significance of the Transformation Process to Transformation Process to

StaffStaff The OASIS assessment drives The OASIS assessment drives

reimbursement for the agency, reimbursement for the agency, supports the physician directed plan of supports the physician directed plan of care and generates the public reported care and generates the public reported outcomes outcomes

Ability to project revenue and prevent Ability to project revenue and prevent down coding of claims down coding of claims

Demonstration projects on pay for Demonstration projects on pay for performance (P4P) currently going on in performance (P4P) currently going on in Home Health Home Health

ConclusionConclusion

Federally mandated changesFederally mandated changes

Direct impact on staff, patients & Direct impact on staff, patients & financesfinances

Educational programsEducational programs

Evaluation & feedbackEvaluation & feedback

QuestionsQuestions

ReferencesReferences